ABSTRACT
Background: Secondary hyperparathyroidism (SHPT) affects a majority of patients with chronic kidney disease (CKD) of stage 3. Despite the development of calcimimetics and their effectiveness in treating SHPT, many patients continue to fail medical management and should be referred to a parathyroid surgeon.
Aim: In this paper, we summarize indications for surgical management of SHPT, preoperative planning, and postoperative management.
Material and method: We performed a retrospective descriptive study of patients operated for SHPT, during 10-years long period (from January 2010 to December 2019).
Results: A total of 51 patients, 33 (64,7%) of whom were males, with a mean age of 41 years old were assessed in this study. All our patients present CKD and 96,1% of them were in end-stage renal disease (ESRD). The main clinical manifestations were bone pain and asthenia. All patients were evaluated by 99Tc-sestamibi scintigraphy. Parathyroidectomy (PT) was performed in open surgery under general anesthesia. The following types of interventions have been performed: PT type ¾ (13,7%), PT type 7/8 (84,3%), total PT with autotransplantation (2%). In patients with associated thyroid disease, thyroidectomies were done (5,9%). Postoperatively, forty-four patients (85,7%) had hypocalcemia immediately postoperatively, corrected by intravenous calcium supplementation.
Conclusions: Management of SHPT can be extremely challenging. PT remains the most effective treatment and would lead to a better quality of life and improved overall survival.
Keywords: Secondary hyperparathyroidism, End-stage renal disease, Scintigraphy, Parathyroidectomy, Hypoparathyroidism
